The Curative Effect Of Conjoint Fascial Sheath Suspension(CFSS) In The Treatment Of Severe Congenital Blepharoptosis

Objective: To observe and compare the curative effect of combined fascial sheath suspension(CFS)in the treatment of severe congenital blepharoptosis。Background: Frontalis muscle suspension(Frontalis Muscle Suspension:FMS)is a method currently applicable,generally accepted in the treatment of severe ptosis,but its disadvantage is obvious:(1)It does not accord with the upper eyelid physiology(2)The time of eyelid closure was longer(3 months-1 years or longer).Levator palpebrae superioris is suitable for the patients with mild to moderate ptosis.This method is more suitable for the upper eyelid,more in line with the levator muscle of upper eyelid physiological requirements than frontalis muscle suspension(FMS),But the levator palpebrae muscle function is poor or completely missing,need to perform a large amount of muscle removal or folding,After the operation,it can also cause a significant time of palpebral fissure closure,and the long-term recurrence rate was higher.Conjoint fascial sheath suspension surgery(CFSS),this method was reported in 2002 by(Hans Holmstrom and Fabio Santanelli)reported in the literature.The authors suggest that this method can be used for the treatment of severe blepharoptosis,with advantages of(1)Compliance with levator palpebrae physiology(2)The eyelid closure time was shorter,it is an index to evaluate the degree of eyelid closure.In this study,we used two kinds of quantitative comparison:(1)MRD1(Marginal Reflex Distance): MRD1 is the distance from the light of the patient’s cornea to the center of the upper edge of the lid(The patients in the main position of gaze).MRD1 is an indicator of upper eyelid ptosis,(2)The upper eyelid lifting capacity,Detection method: the examiner with the thumb along the long axis of the eyebrows to press the forehead muscles,first instructed the patient to close his eyes,and then ask the patient to head up,at this time the upper eyelid movement distance for the upper eyelidMethod: Methods a retrospective review of medical records and files of patients with preoperative and postoperative patients with standard digital photos of index data in vivo measurement,and statistical comparison of complications.A total of 25 patients with severe congenital ptosis(33eyes)were included in the study.There were two eyes and a monocular in,with an average age of 25 years(range,11-40 years).A group was divided into two groups: Group A(FMS)14cases(17eyes)and group B(CFSS)11cases(16eyes).The measurement of MRD1 and upper eyelid lift capacity was measured at 1and 6 months after operation.SPSS 17 statistical analysis software was used to analyze the preoperative and postoperative observation indexes.Completely randomized controlled t test,p<0.05,the difference was statistically significant.Results: Two groups of MRD1 ratio after operation for 1 months: FMS group was 2.82±0.907,the CFSS group was 2.84±0.068,P>0.05,the difference was not statistically significant.After 6months of the operation,the MRD1 ratio,the FMS group was 2.81± 0.964,the CFSS group was more than the value of 4.13 ±0.071,P<0.05,the difference was statistically significant.The two groups after1 month operation,the upper eyelid lifting capacity,the amount of ratio: FMS group was 3.69±0.068,the CFS group was 4.13±0.071,P<0.05,the difference was statistically significant.The two groups after operation 6months,the upper eyelid lifting capacity,the amount of ratio: FMS group was5.13±0.081,the CFS group was 5.35±0.073,P<0.05,the difference was not significant.Conclusion: Compared with the frontal muscle flap suspension method,CFSS has the same effect in the correction of severe blepharoptosis,but the duration of eyelid closure is significantly shorter.